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Tex Program Tax Period Assessment Tax Penalty Interest Costs Total Due Individual 2014 08/07/2015 211.00 10.55 5.34 226.89 Total $226.89 Feb. 19. 2516 2:11PM NE Secretary of State — UCC 1 Nebraska Department of REVENUE This Notice of State Tax Lien is Issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner. Taxes; including penalties, interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand.These taxes are a lien for all property located in the county and rights to property owned by the taxpayer or acquired before the expiration of this lien, This lien will expire and become unenforceable 10 years after the date of recording it no continuation statement Is recorded on or prior to the expiration of the previous lien or continuation statement. Nebraska ID Number 93770138 Lien Serial Number 11665696 Dale of Llen 02/17/2016 sign here Lion Filed With (I Register of Deeds 0 County Clerk Lien type: X] Original Business Name and Location Address Signature 201601030 Notice of State Tax Lien Federal ID Number Social Security Number XXX -XX -3381 flContinuation D Corrected PLEASE DO NOT WHITE IN THIS SPACE County HALL Taxpayer Name and Mailing Address SEBASTIAN ZACARIAS MEJIA 504 N ELM ST APT 136 GRAND ISLAND NE 68801 Na.5153 P. 5/5 111111141 11111111 5 111 9916788886_3 Pus I Filed:50 1 0:1 6s nil Spouses Social Security Number I earthy that the Nebraska Depattmeni of Revenue has compiled with the laws of gm Slate of Nebraska in determining iho amount shown to be due, and that the taxpayer has failed • pay the amount due after demand. This Notice of State Tax Denis an effective Hen and serves to continue the priority of the Slate . - est in the aft ed property of the taxpayer. Revenue Agent Tito Revenue Supervisor Tills 02/17/2016 (402)471 -6043 Date Phone Number 02/1712016 Date 4-49e-1 974 Pee.5.201 s supereedee 4-e0O-1974 Rev. 040112